Effective management of acute whiplash injuries requires a pragmatic approach: An RCT with stratified treatments

机动车碰撞造成的颈部扭伤，仍会给社会和保险业带来巨大的个人和经济损失。在澳大利亚和国际上，目前对急性颈部扭伤的治疗方法未能降低许多人患上慢性颈部疼痛的比率。40%到60%的人在受伤6个月后仍然疼痛。汽车事故保险委员会（Qld）的数据显示，20%的慢性鞭伤患者承担了60%的费用。必须防止从急性到慢性的过渡。急性期治疗的新方向是迫切需要的，因为一旦疼痛变成慢性，很难帮助。本研究将对急性颈部扭伤进行一项新的随机对照试验。它将测试单独处方的多专业管理与常规护理的对比，目的是减少继续发展为慢性疼痛的人数。这将是第一个从一开始就承认颈部扭伤会以不同的方式伤害和影响人的临床试验。我们以前对急性颈椎扭伤患者的研究已经从生理、生理和心理的角度记录了表现的变化。在这项试验中，治疗将根据个体可测量的疼痛、肌肉和心理损伤来指导，而不是像在其他试验中一样将所有患者视为相同。这项试验将提供个体化治疗；医学，物理治疗和或心理治疗，使用经验推导的治疗算法。该计划的成本效益将与常规护理期间产生的成本效益进行评估。据预测，从长远来看，早期的多专业管理将比现有的方法成本更低。这项随机对照试验旨在扩大对鞭打相关疾病（WAD）管理的认识。

Whiplash injuries from a motor vehicle crash continue to incur substantial personal and financial costs to the community and the insurance industry. The current approaches to an acute whiplash injury in Australia and internationally have failed to lessen the rate of how many people develop chronic neck pain. Between 40 and 60% still have pain 6 months after injury. Motor Accident Insurance Commission (Qld) figures indicate that 20% of patients with chronic whiplash account for 60% of the costs. Transition from an acute to a chronic condition must be prevented. A new direction in management in the acute stage is urgently required as once the pain has become chronic, it is difficult to help. This research will conduct a novel randomised controlled trial for acute whiplash. It will test individually prescribed multi-professional management against usual care with the aim to lessen the numbers who go on to develop chronic pain. It will be the first clinical trial that acknowledges from the outset that the whiplash injuries and affects people in different ways. Our previous research with acute whiplash patients has documented the variations in presentation from physical, physiological and psychological perspectives. In this trial, management will be prescribed as directed by measurable pain, muscle and psychological impairments in the individual, rather than regard all patients as the same as in other trials. This trial will offer individualised treatments; medical, physiotherapy and-or psychological using an empirically derived treatment algorithm. Cost-effectiveness of the program will be evaluated against that incurred during usual care. It is predicted that early multi-professional management will be less expensive in the long term than existing approaches. This RCT stands to extend knowledge in the management of whiplash associated disorders (WAD).